“I don’t recognize you in makeup!” and other pitfalls of Capgras syndrome

When looking at someone you know well, have you ever felt like you were seeing the face of someone you didn't know? More confident, angrier, or, on the contrary, colder than usual - in any case, before this you knew someone completely different.

In situations that bring out the most unexpected in people, it is sometimes impossible to recognize even those closest to you. Perhaps you have sometimes said about yourself: “It’s not me, someone has definitely taken possession of me!” Well, then you can imagine in general terms the everyday emotions of people suffering from Capgras syndrome.

Capgras syndrome - definition and history of research

The “Psychiatric Encyclopedic Dictionary” gives the definition: “False recognition by mental patients of unknown persons who are mistaken for acquaintances, relatives, or, conversely, acquaintances are mistaken for strangers who take the form of acquaintances” [7, P. 399]. A person with Capgras syndrome may believe that he himself has been replaced by a double acting on his behalf.

The syndrome, originally defined as the "double illusion", is named after the French psychiatrist, Jean Marie Joseph Capgras. In 1923, together with Jean Reboul-Lachaux, he described the case of a certain “Madame M.” For 10 years, the woman claimed that her husband, daughter, neighbors and others were replaced by doubles. Moreover, Madame M. believed that the doubles even replaced each other! For example, a lady counted as many as 80 duplicates of her husband (in her opinion, killed long ago) [3, p. 150]. And during the divorce of the spouses, in the column “Reason for divorce,” Madame M. wrote: “Substitution of husband.”

In addition to a firm belief in the substitution of relatives and friends (thought disorder), she also exhibited paranoid ideas, episodes of megalomania, and auditory hallucinations [1]. This variety of symptoms indicated that Capgras syndrome does not come alone and tends to progress.

Clinical picture

Capgras syndrome is a paranoid obsessive disorder. It comes in two types:

• The man is sure that in front of him is a double. He sees him, talks to him, argues with his opponent, can touch him, and so on. He shows it to the doctor, that is, the object is visible to everyone without exception.
• The patient does not physically see the twin. But at the same time she constantly feels his presence nearby. In this case, the double remains invisible not only to him, but also to society.

What is most interesting: the patient’s suspicion can fall not only on a specific person, but also on an animal or object. Hallucinations are not observed in a person suffering from a personality disorder. Often a person even realizes that he is sick and his perception of reality is abnormal and false. Doctors have noticed that women are more susceptible to the disease. Sometimes it is accompanied by schizophrenia or injury to the posterior region of the right hemisphere of the brain, which is responsible for recognizing people's faces and inanimate objects.

Types of Capgras syndrome

Capgras syndrome includes delusions of intermetamorphosis, delusions of negative/positive double and Fregoli syndrome [7].

1. Delusion of intermetamorphosis (or “metabolic delirium”) is a person’s pathological belief that certain persons change their appearance and/or internal essence so that he does not recognize them. This is accompanied by confidence in the evil intentions of these people [4]. Sometimes it is combined with delusions of staging - the perception of a real situation as being played out specifically for the patient (as in the film “The Truman Show”).
2. The delusion of a negative double is a person’s belief that his loved ones (and sometimes himself) have been replaced by a double or someone similar, disguised and made up. The patient is sure that his loved ones were killed or kidnapped, but so that no one would guess, they found replacement people. Usually it is this branch that is called Capgras syndrome itself.
3. Delusion of a positive double is a person’s false recognition of people they know or are close to him in strangers.
4. Fregoli syndrome is a reverse delirium of intermetamorphosis. The patient is firmly convinced that all strangers are “played” by the same person familiar to him and pursues him, taking on the appearance of other people [5].

Treatment of negative twin syndrome

Treatment of Capgras syndrome should be comprehensive. It includes medication and the help of a psychotherapist.

Drug therapy

Typically, the doctor prescribes the following medications:

• Neuroleptics. Suppress the production of delirium. Improvement occurs after the first dose.
• Antidepressants. Help the patient calm down, relax, and get rid of anxiety and fear. Reduce activity, including those associated with imaginary doubles.
• Anticonvulsants. These drugs were used not so long ago. They inhibit the functioning of overly active areas of the cerebral cortex. Medicines are taken from several days to several years.

Capgras syndrome is treated in courses, as relapses often occur.

Psychological help

During the treatment process, psychotherapists use two techniques:

• reformulation;
• testing in practice.

The first involves changing the patient's thinking. The doctor tries to show how absurd his story is. Or proves in various ways that there are no doubles.

Reality tests require a person to answer several questions. They are not asked directly. They are presented in the form of simple tasks that do not require intense mental activity. This is the first part of the treatment. In the second, the specialist analyzes what he heard. He presents his findings to the patient, showing him his problems and concerns. Together we develop a plan to solve and eliminate them.

How does Capgras syndrome occur?

Researchers and practitioners have not yet come to a consensus on the syndrome. There are several theories about its origin:

1. Freudian concept. The syndrome is seen as the repression into the unconscious of “unacceptable” feelings and emotions towards a loved one (for example, a feeling of sexual interest in oneself on the part of the family member who has been “replaced”). Thus, the patient “splits” the relative’s personality into “good” and “bad” - that is, the relative himself and the stranger who pretends to be him. The latter bears “responsibility” for the emotional discomfort that causes such a deep intrapersonal conflict in the patient.
2. The neuropsychological concept states that Capgras syndrome is often accompanied by pathological changes in the brain (namely, the frontal and temporal lobes of the right hemisphere), which can be caused by head injuries, diseases - dementia, schizophrenia, cerebrovascular disease.
3. Vileyanur Ramachandran's concept is one of the most famous and cited theories of the origin of this group of syndromes. The syndrome appears here as a disruption of communication between two key areas of the brain - the fusiform gyrus (face recognition) and the amygdala, which is responsible for the emotional response to faces. Normally, these two areas, interacting with each other, give, for example, the following picture of the world: “This is my husband and I love him.” In patients with Capgras syndrome, according to the researcher, facial recognition does not entail a corresponding emotional response: “This man looks like my husband, but this is not my husband - the face does not evoke in me the feelings that were there before. He must have been replaced by a double" [2].

Ramachandran derived this theory from observations of his own patient, David, who, after suffering a serious head injury, woke up from a five-week coma to believe that his parents had been replaced by doubles. An interesting detail - David believed that the “doubles” were in some ways more skillful than the “real” parents - his father drove a car more skillfully, his mother cooked much more deliciously. This is exactly how, according to him, he determined the fact of substitution [6].

1. One of the newest concepts in this area is the concept of psychiatrists Nicola Edelstein and Femi Oyebode. It is an addition to Ramachandran’s theory and consists in detecting pathological changes in patients in the prefrontal cortex of the brain, which is responsible for setting goals, designating behavioral strategies, and making decisions. Edelstein and Oyebode suggested that it is precisely because of the disruption in these processes that the above-described conclusion “This man looks like my husband, but is not him” does not seem strange and unusual to the patient, and there is no criticism of his condition [2].

Agree, even after a detailed analysis, it is not easy to believe in the existence of the syndrome. It is even more difficult to imagine the variety of patterns of its development and symptoms in different people. An example of an even more unusual development of the syndrome is the story of a 71-year-old American man with bipolar affective disorder. After refusing drug treatment, the patient began to have delusional ideas - he believed that the FBI was watching his house. The apotheosis (and at the same time the manifestation of Capgras syndrome) was the moment when the man became convinced that his cat had been replaced. According to him, the “New” cat, in collusion with the FBI, followed him and his family, passing on the information he received. Psychiatrists Darby and Kaplan, of whom the patient was a patient, gave the syndrome a new name “Katgra”.

However, despite the many variations and complexities of the disorder, Professor of Psychiatry N. Edelstein believes that with the passage of time and the advent of more and more scientific research, the picture is becoming clearer, and the syndrome “ceases to be part of the neurological “X-Files” [2]. The syndrome is also interesting in how clearly it manifests the fear of the very phenomenon of duality, the fact of being replaced by a double - another person who exactly copies the “original”. We will talk more about the doppelganger and the unconscious fear of the double in the next article.

Symptoms

Capgras syndrome begins to progress after the age of 30. Before this, it may be in a sleeping, or latent, state. Although science knows cases where teenagers or even children fell ill. For example, a case was described in psychiatry where the first signs of the disease appeared in a 15-year-old girl. She was sitting with her brother and father in a cafe and suddenly suddenly announced that drugs were being slipped into her food. Already in the medical institution, she mistook her mother for an impostor, and called the night orderly her father, who came only to cause her physical and mental suffering.

From this we can conclude that absolutely unexpectedly a person develops Capgras syndrome. Symptoms, in addition to confusion between people and doubles, also manifest themselves in the form of aggressive behavior. Firstly, a person gets angry because they don’t believe him. Secondly, he becomes enraged at the perceived threat. Being afraid of someone or something, he can also become neurasthenic, intimidated, cautious, depressed and apathetic. Thirdly, the patient begins to use violence against close relatives. Sometimes it even comes to the murder of entire relatives and subsequent suicide.

As exciting as it is terrifying?

This can be said about Capgras syndrome, which is very cinematic in its description. This theme has been repeatedly embodied in films and books. There are many famous masterpieces of literature and cinema that take up this topic.

Capgras Syndrome has also been featured in Criminal Minds, The Stepford Wives and many others - a clear indication of the disorder's appeal, which is certainly due to the fact that it affects people in general, generating great interest in it. . After all, many are concerned about the question of how real the surrounding reality is.

Is it possible to cure the disease?

It all depends on what caused Capgras syndrome to develop. For example, if it is found in a patient already suffering from schizophrenia, then he can be quickly helped. Properly prescribed medications suppress even a very anxious state, constantly arising fears and suspicions. If the cause of the syndrome is a head injury, then doctors for some time do not prescribe treatment for the syndrome, giving the brain the opportunity to correct its own work. In most cases, the gray matter independently suppresses the imaginary images that breed in its imagination.

As for the stress experienced, in this case it can be quite difficult to heal the patient. Having survived a tragic event, he becomes so isolated in his fictional world that it is not easy to reach him. Moreover, he himself does not want to be “extracted” from the depths of his fantasies. Despite this, prescribed psychotropic therapy helps control the condition, making the person safe for society. After all, obsessed with constant paranoid fears, he is capable of causing enormous harm not only to his family, but also to many other people. Such patients are potential murderers, maniacs and terrorists.

Modern diagnostic methods

A person with such symptoms requires hospitalization - only in an inpatient setting, with constant monitoring, a psychiatrist can make the correct diagnosis. A distinctive feature of this syndrome is that the patient accurately identifies people’s faces (the results, naturally, do not coincide with reality), names them, but cannot tell by what criteria he recognized this or that person.

Of course, some examinations are also carried out that help supplement the collected anamnesis and determine the possible cause of the development of the disorder. For example, tests are needed to determine the content of alcohol and drugs in the body. Tomography, encephalography and other studies may be performed to help determine the presence of organic lesions in the brain.

Reasons for appearance

The clinical picture is described in detail by world-famous psychiatrists. They professionally studied Capgras syndrome: photos of difficult patients, videos of the most delusional monologues were analyzed in detail by them, and the correct conclusions were drawn. Instead, the causes of the disease still remain vague and not fully understood. They say that the main impetus is damage to the back of the right hemisphere of the brain, which controls the recognition and recognition of people's faces and the appearance of objects. This can result from a severe head injury or unsuccessful surgery.

Another hypothesis states that the appearance of the syndrome has a psychological rather than a physical basis. That is, very severe stress experienced by the patient can lead to this. Often the disease begins to progress much later than the tragedy has occurred. That is, several months, years, even decades may pass after the accident before the syndrome begins to develop. Some psychiatrists admit that the tendency to illness is inherent in the womb of the mother. Others argue: it becomes a consequence of a difficult childhood or authoritarian upbringing.

Main forms of the syndrome

Doctors say that mentally unstable individuals are especially susceptible to this disease. In addition, they distinguish several forms of the disease:

1. Fregoli syndrome. This is a “mirror” version of the disorder described above, when the patient “recognizes” his relatives in strangers. Capgras and Fregoli syndrome are very similar in their essence and manifestations.
2. The incubus phenomenon is a mental disorder when the patient begins to claim that during night dreams he enters into sexual contact with an imaginary lover.
3. The phenomenon of delusional hermaphroditism. Described in 1999. It was first discovered in a young man who tried to convince doctors that he was being persecuted by a literary character who was possessing people around him.

Some patients say that another personality lives in the middle of them, who talks to them, controls their actions and even drinks all the juices of life. Other patients mention microorganisms with which they are allegedly infected.